Poster Session 3: Incontinence and overactive bladder| Volume 8, ISSUE 8, P618, September 2009

S33 Initial experience with the third generation suburethral sling “TVT secur” not as good as it was expected

      Introduction and Objectives

      Stress urinary incontinence (SUI) is a common clinical problem, that is successfully solved with tension free tapes suprapubic or transobturatory. Complications although infrequent, could be life threatening, during the placement of TVT. Residual symptoms after TOT are also common. Residual symptoms deteriorate postoperative quality of life regardless excellent results regarding continence rate (80–90%). The idea of third generation sling is to make surgery less traumatic (single incision), and to pass the shortest possible way in the body and, so minimize tissue trauma and the risk of complications.

      Material and Methods

      During 2007–2008, sixteen patients with clinically confirmed SUI were operated. “TVT secur”-third generation sling (Johnson & Johnson, Gynecare, Somerville NJ, USA) was used, and placed with “U” technique. The main criteria for patient selection were: clinically confirmed SUI, urethral hypermobility (Qtip > 30 degrees) and negative “Barrier” test, The bladder function was confirmed with basic urodynamic data before the surgery (voiding dairy, first sensation, bladder capacity, and compliance on dynamic urethrocystoscopy). There was no significant pelvic organ prolapse. Szmptom evaluation was performed with ICIQ/SF questionnaire before and after the surgery. Follow up time was between three and fifteen months (mean 8.3 months).


      All patients were operated in LMA (laryngeal mask airway) anesthesia. Time of surgery was progressively. shortened from 24.5 minutes, to 19.6minutes. Continence was achieved in 13 out of 16 patients (81.2%). Intraoperative complications were: unintended displacement of the sling (1–7.7%) and bleeding (1–7.7%). Temporary urinary retention occurred in one case (7.7%). Symptom score measured with ICIQ/SF was significantly improved (p-0.000). There was no postoperative urgency. Postoperative hospital stay was 1.4 days. (See figure.)
      Figure thumbnail fx1


      Initial success rate with “TVT secur”, in a selected group of patients is high but not as high as we have experienced with TVT and TVT-O. Problem that remains is success rate in cases with SUI and ISD. Safety and short term tape efficiency are the most important problems we are dealing with. It seems that group of patients that are convenient for “TVT secur” must to be more strictly defined. Although complication rate is lower, in comparison with TVT(TOT), this sling type surely must pass the test of time.